Governors grapple with an aging America

Call for need to reshape tax codes, social services

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SEATTLE — Gray hair is the least of it. Aging poses sharp challenges to those lucky enough to face it, from mobility to mental health to independence. As tens of millions of Americans approach the age of 65, the care and costs are increasingly critical to the nation.

States can take the initiative in transforming the elderly experience by reshaping health care, social services and tax codes to help the rapidly growing population of those 65 and older, governors agreed Sunday at the summer meeting of the National Governors Association.

Outside the downtown hotel, hundreds of disabled protesters in wheelchairs shut down traffic, seeking support from the governors to force Medicaid to more quickly turn to home-based long-term care, rather than relying on institutions. States have had to get waivers from federal officials to pursue such programs.

The three-day gathering, which ends Monday, brought no sweeping commitments or new programs, but rather a close look at the areas where state government could step in to focus attention, resources and support for the elderly. Among the recommendations that some states have already tried:

Streamline paperwork so elderly hospital patients can go straight to home-based care rather than nursing homes.

Work with local and regional governments to promote “elder-ready” communities where transportation, shopping and social services are easily accessible.

Broaden tax deductions or tax credits for caregivers’ expenses.

Within eight years, many of the nation’s 77 million “baby boomers” will begin turning 65, said Idaho Gov. Dirk Kempthorne, a Republican. And estimates show nearly half could be bankrupted by trying to get long-term care, he said.

“What kind of future is that to be looking for?” Kempthorne said. As the outgoing NGA chairman, he has led the governors to concentrate attention on the problem and to share ideas.

Medicaid's bite of the budget
Of particular concern for governors is the huge share that Medicaid eats from state budgets, and the driving force of the elderly behind the growing Medicaid program.

State officials estimate that elderly and disabled populations account for some two-thirds of the budget of Medicaid, the joint state-federal health care program for the poor. The combined state-federal Medicaid program costs about $300 billion a year, and accounts for roughly 20 percent of state budgets on average.

Several hundred people with ADAPT, a national disability rights group, rallied outside the hotel, rolling wheelchairs into intersections to stop traffic, pushing for more attention to the issue governors were discussing inside. There were no arrests by mid-afternoon.

A question of choice
“The goal is for people to be able to choose if they want to receive long-term care in their own home or in nursing homes,” said Marsha Katz, a coordinator for the group. “They would literally rather go to jail than go into a nursing home.”

Katz said that a few governors had reached out to the group, but that the association overall had refused to meet with them.

Governors already have been urging more flexibility from federal officials. Roughly 30 percent of the 2.5 million people getting long-term care from Medicaid are served at home or through community-based programs, said Matt Salo with the NGA.

“This is a huge national issue both because of the aging population and with regards to the costs of caring for this population,” said Ohio Gov. Bob Taft, a Republican. “We need to move forward in the most caring way and in a way we can afford.”